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AS VS Treatment. Who recommends which? R1194

This article states that Academic Urologists, who do research opt for Active Surveillance, whereas most urologists in private practice, including working at a hospital, opt for treatment. Could financial considerations be a factor?
The following is part of this article. To read the entire article use the URL at the end

More Men With Early Prostate Cancer Are Choosing to Avoid Treatment
NY Times By GINA KOLATA MAY 24, 2016

Seemingly overnight, treatment of men with early-stage prostate cancer has undergone a sea change. Five years ago, nearly all opted for surgery or radiation; now, nearly half are choosing no treatment at all.
The approach is called active surveillance. It means their cancers are left alone but regularly monitored to be sure they are not growing. Just 10 percent to 15 percent of early-stage prostate cancer patients were being treated by active surveillance several years ago. Now, national data from three independent sources consistently finds that 40 percent to 50 percent of them are making that choice.

In recent years, major research organizations have begun to recommend active surveillance, which for years had been promoted mostly by academic urologists in major medical centers, but not by urologists in private practice, who treat most men. In 2011, the National Institutes of Health held a consensus conference that concluded that it should be the preferred course for men with small and innocuous-looking tumors. Last year, the American Society of Clinical Oncology issued guidelines with the same advice.

After surgery to remove the prostate, more than 30 percent of men have a recurrence, and until now there has not been clear evidence about the best way to stop the disease from killing them. Most are given radiation, but prescribing drugs to counter the effects of male hormones has been inconsistent.
The study, paid for by the National Cancer Institute, showed that among men who received radiation and hormonal treatment, 76.3 percent were still alive after 12 years, compared to 71.3 percent who had radiation alone.

At 12 years, the men who had both treatments were also much less likely to have died from their prostate cancer — 5.8 percent versus 13.4 percent — or to have the cancer spread around their bodies — 14.5 percent versus 23 percent.

“This is a big deal,” said Dr. Ian M. Thompson Jr., of the Christus Santa Rosa Health System in San Antonio, who was not part of the study but wrote an editorial accompanying it.
“There are so many things we do in prostate cancer that we don’t know if they make a big difference in survival. This is one of the things where now we can say for sure.”
He added that he hoped the findings would change medical practice.

The medical term for blocking male hormones is chemical castration, and the treatments can cause hot flashes, sexual problems and other side effects. So to put a man through it, said Dr. Anthony L. Zietman, an author of the study, “you’d better have some decent justification.”

Dr. David F. Penson, the chairman of urologic surgery at Vanderbilt University Medical Center, said the study “gives more credence to the concept that you have to treat the whole patient,” rather than just irradiating the area where the cancer used to be.
He said the idea of blocking hormones in men like those in the study was finding its way into medical practice.

The study, begun in 1998 and led by Dr. William U. Shipley, a radiation oncologist at the Massachusetts General Hospital, had an ambitious goal: to follow the patients long enough to find out whether hormone-blocking treatment would affect their survival.

Prostate cancer grows slowly, so it took well over a decade for answers to emerge. Researchers and patients from 150 sites in North America participated. The patients were 760 men who had their prostates removed for cancer that had not spread, but who then had a sign of recurrence — a rise in their blood levels of prostate-specific antigen, or PSA, a protein associated with prostate cancer. The men in the study had PSAs of 0.2 to 4 nanograms per milliliter.

“That’s just like the first wisp of smoke,” said Dr. Zietman, who is a professor of radiation oncology at Massachusetts General Hospital and Harvard Medical School. “There’ll be fire someday.”
The fire might take five, 10 or 15 years to break out, but Dr. Zietman said, “Many are in their 50s or 60s, and will live long enough to get into trouble.”

The traditional practice for a rising PSA after surgery has been to give radiation, which targets only the pelvis.
The idea of the study was to add hormonal treatment, which might stop minute clumps of cancer that had spread to other parts of the body.

All the men in the study had radiation for six and a half weeks. For two years, half also received a hormone-blocking drug, bicalutamide, and the other half were given placebos. They were followed, on average, for about 13 years.

“This is the first trial that’s shown, if you follow these patients long enough, there is a real difference,” Dr. Zietman said. “More people survive 15 years later.”

Men who had more aggressive cancers — reflected by higher PSA readings after surgery and by the pathology and surgical reports on their tumors — had the most to gain from the hormone-blocking treatment.

The results do not mean that every man with a rising PSA after surgery should have hormone treatment, Dr. Zietman said. Men 75 or older may not need it, because they may die from other causes before the cancer can catch up with them.
“But if they’re younger and with a longer life expectancy, treatment is reasonable,” he said.
Bicalutamide causes men to develop breasts and potentially other problems, and the high dose given in the study is no longer used in the United States.
Other hormone-blocking drugs like Lupron have mostly taken its place, and may be even more effective, Dr. Zietman said. The study proved the concept that hormone blocking increases survival, he added, so other drugs that do the same thing should also help patients live longer.

Another study in progress in Canada and Europe uses the newer drugs, and is trying to determine whether taking them for six months, rather than two years, might be enough.

Men who carry mutations of the tumor-suppressor gene BRCA2 are at higher risk of developing prostate cancer, and chances are they will have a more aggressive form of the disease, but researchers have only now understood why this happens. (Note 1)
A recent study has shown that BRCA2 mutations trigger genetic changes in prostate tumors that resemble those seen in metastasis — or cancer spreading to other organs. The mutations lead to more aggressive disease and poorer prognosis.
The research emphasizes the importance of genetic testing in prostate cancer, which can improve personalized treatment and lead to better outcomes.

Prostate tumors in men with BRCA2 mutations are very aggressive, associated with younger age of onset, affect the lymph nodes more often than non-BRCA2-mutant tumors, and lead to higher patient mortality rates.
In these patients, localized prostate cancer rapidly progresses to metastatic castrate-resistant prostate cancer. This form of the disease no longer responds to standard hormone therapy, and one result is a five-year survival rate of only 50-60 percent.

To understand why BRCA2-mutant prostate cancers are so aggressive, an international team of scientists, led by Australia’s Monash University Biomedicine Discovery Institute (BDI), sought to characterize the genomic alterations seen in men with localized prostate cancers who inherited BRCA2 mutations.
After extensive analysis of localized prostate tumor specimens from 14 men with BRCA2 mutations — collected during surgical removal of tumors — the team compared their data with that in a companion study.

The other study, led by collaborators in the Monash-led study, looked at prostate cancer samples from more than 320 patients without BRCA2 mutations. The research was published in Nature at the same time as the Monash study.
Surprisingly, the team found that localized prostate tumors of patients with faulty BRCA2 were genetically similar to the metastasis seen in men with metastatic prostate cancer. This genetic profile, which was associated with the activation of signaling pathways that rendered the cancer more aggressive, was rarely observed in localized prostate cancer of men lacking BRCA2 mutations.

Together, the findings explained why men with BRCA2 mutations have more aggressive disease, and suggest they should be managed with aggressive treatment at the time of their diagnosis to improve their outcomes.

“As the tumors in men with the BRCA2 gene fault are so different from the ‘get-go,’ our findings raise the question about whether these patients should be managed differently at diagnosis,” Dr. Renea Taylor, a fellow at Monash who led the study, said in a press release.

“[T]hese new findings detailing the genomic instability of BRCA2 prostate cancer are important as we may be able to target this with new therapies,” said Declan Murphy,director of Genitourinary Oncology at the Peter MacCallum Cancer Center and study author.

Early hormonal therapy hikes death rate in men with recurrent low-risk prostate cancer.

This article discusses the danger of a recurrence, and perhaps death if the PSA does not decrease to a low level after treatment.

It was written by Dr. Marc Garnick, MD, a Medical Oncologist at the BIDMC, who is Editor in Chief of the “2016 Annual Report on Prostate Diseases”, which is published by the Harvard Medical School. It is on page 7

Study Finds New Way to Pinpoint Dangerous Prostate Cancer by Maggie Fox 1/12/ 2017.
Researchers say they’ve found a new way to tell if a man’s prostate cancer will come back and kill him after treatment.
If a blood test called a PSA doesn’t fall to low enough levels after treatment, it means the cancer’s not all gone and will likely come back and spread, the team at Brigham and Women’s Hospital and Harvard Medical School reported. PSA tests look for prostate specific antigen, a protein made only by prostate cells. Higher PSA levels suggest that prostate cells are growing — often because of cancer, but sometimes if the prostate is inflamed or because of the harmless enlargement of the prostate that comes with aging.
The important number to know: PSA should fall to 0.5 nanograms (ng per ml) or lower. That gives doctors a chance to act right away, said Dr. Anthony D’Amico, the senior oncologist on the study. “Instead of waiting to see if PSA has gone up, this can tell you that somebody has not only failed treatment, but failed so badly that they are going to die of prostate cancer,” D’Amico told NBC News. “You should know what your PSA is after your treatment. You need to know once it stops going down if that low point is above half a point (0.5).”

“By identifying and enrolling these men in clinical trials immediately, the hope is to take a prostate cancer that appears to be incurable and make it curable” added Dr. Trevor Royce, who led the work on the study. It’s an important question.

Prostate cancer is very common, showing up in 240,000 U.S. men every year. It kills about 30,000 a year. In most men, prostate cancer isn’t likely to kill them before something else does. But since prostate cancer still kills so many men, it’s important to find out which men are most at risk of dying early. This new study shows that PSA can tell you.

PSA’s not a very good indication of cancer, but it’s a good measure of how well cancer treatment has worked. PSA should drop to very low levels after surgery or radiation treatment for cancer. But it doesn’t always, and it often rebounds. “Normally, a man gets treated for prostate cancer and his PSA is monitored every six months for a few years. In order to call somebody a failure, that the disease has recurred, you need to see a PSA that is going up.” But not every man whose PSA goes up after treatment dies of cancer. And not every prostate cancer patient is saved by fresh treatment once his PSA rises to a certain level, usually a reading of 10.

The Harvard team wanted to see if there’s a more precise way to tell who had the more dangerous cancer. They studied 157 men treated for prostate cancer, watching them for more than 16 years on average. Most — 70 percent — died by then. “Men were seen in follow-up every three months for two years, every six months for the subsequent three years, and every year thereafter,” the team wrote in their report, published in the Journal of the American Medical Association’s JAMA Oncology.

The main determinant of whether the men would die, the team found, was how low their PSA level fell. If it did not drop to 0.5 after treatment, the men were most likely to have the cancer come back and kill them, D’Amico said. “If it doesn’t drop below this half point in follow-up … you know that person not only has residual prostate cancer, but the type of prostate cancer that often goes on to kill them,” D’Amico said.

Just having PSA levels rise again was not a very good predictor of whether the men would die, the team found. Now doctors need to see if treating these men right away, instead of waiting for their PSA levels to rise more, may save them, D’Amico said. “Before, we saw this number and said ‘gee we are concerned but let’s watch,'” he said. Now doctors can act.

There are many drugs that prostate cancer patients can get, but they’re almost never given until the cancer’s come back and started causing symptoms.

“You know that person not only has residual prostate cancer, but the type of prostate cancer that often goes on to kill them.” “These are treatments that are used when a man has metastatic disease. They have been shown to prolong life but not to cure it,” D’Amico said.

It might be if a patient gets such treatment right away, he could live even longer or perhaps even be cured. But a study will have to be done to show it. The men in the study had radiation or hormone therapy, but D’Amico said the finding should hold for men who have had their prostates surgically removed, also.

“You should know what your PSA is after your treatment. You need to know once it stops going down if that low point is above half a point (0.5),” D’Amico said.

==========================================================We all know how expensive cancer treatments can be. Cure Magazine has a special issue containing three (3) articles on how to obtain financial help.

A new study provides a major link between low levels of vitamin D and aggressive prostate cancer.
Northwestern Medicine research showed deficient vitamin D blood levels in men can predict aggressive prostate cancer identified at the time of surgery.
The finding is important because it can offer guidance to men and their doctors who may be considering active surveillance, in which they monitor the cancer rather than remove the prostate.
“Vitamin D deficiency may predict aggressive prostate cancer as a biomarker,” said lead investigator Dr. Adam Murphy, an assistant professor of urology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine urologist.
“Men with dark skin, low vitamin D intake or low sun exposure should be tested for vitamin D deficiency when they are diagnosed with an elevated PSA or prostate cancer. Then a deficiency should be corrected with supplements.”
Previous studies showing an association between vitamin D levels and aggressive prostate cancer were based on blood drawn well before treatment.
The new Northwestern study provides a more direct correlation because it measured D levels within a couple of months before the tumor was visually identified as aggressive during surgery to remove the prostate (radical prostatectomy).
The relationship between vitamin D and prostate cancer may explain some disparities seen in prostate cancer, especially among African American men.
Prior research by Murphy and colleagues showed African American men who live in low sunlight locations are up to 1½ times more likely to have vitamin D deficiency than Caucasian men.
But because vitamin D is a biomarker for bone health and aggressiveness of other diseases, all men should check their levels, Murphy said.
“All men should be replenishing their vitamin D to normal levels,” Murphy said. “It’s smart preventive health care.”
Aggressive prostate cancer is defined by whether the cancer has migrated outside of the prostate and by a high Gleason score.
A low Gleason score means the cancer tissue is similar to normal prostate tissue and less likely to spread; a high one means the cancer tissue is very different from normal and more likely to spread.
The study is published in the Journal of Clinical Oncology. Murphy collaborated on the study with Rick Kittles, associate director of cancer disparities at the University of Arizona Cancer Center.
The study was part of a larger ongoing study of 1,760 men in the Chicago area examining vitamin D and prostate cancer.
The current study included 190 men, average age of 64, who underwent a radical prostatectomy to remove their prostate from 2009 to 2014.
Of that group, 87 men had aggressive prostate cancer. Those with aggressive cancer had a median level of 22.7 nanograms per milliliter of vitamin D, significantly below the normal level of more than 30 nanograms/milliliter.
The average D level in Chicago during the winter is about 25 nanograms/milliliter, Murphy noted.
Most people in Chicago should be on D supplements, particularly during winter months, Murphy said.
“It’s very hard to have normal levels when you work in an office every day and because of our long winter,” he said. The Institute of Medicine recommends 600 international units of D per day, but Murphy recommends Chicago residents get 1,000 to 2,000 international units per day.

Stan’s Comment: This article does not mention the percentage of men on A/S who

needed treatment or who died, but I assume the numbers are very low otherwise

the Swedish doctors would have discouraged the men from doing A/S.

I believe A/S is safe if you meet the criteria for A/S

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All PC Treatments About Equally Effective for Low Grade Disease

At our August support 2016 Group meeting, Dr. Anthony D’Amico predicted that we will hear some excellent news about prostate Cancer. On September 15, 2016 the NE Journal, and countless newspapers around the country reported that an English Study has concluded that men who have a low grade PC will do equally well if they have Surgery, Radiation or Active Surveillance (A/S), up to 10 years. The men were randomly assigned, and men on A/S were treated only if their cancer progressed.
I have read 6 different newspaper articles about this study, and not one doctor challenged the results of this conclusion. A few mentioned that if a man does A/S he must be tested for the remainder of his life, but omitted to mention that this is also true if the man was treated shortly after diagnosis, i.e., a recurrence.
The death rate for men who meet the criteria of A/S, and also the men treated shortly after diagnosis is the same at one percent, which is excellent. This includes men on A/S who never needed treatment and those who needed treatment and received it.
About 1/2 of the men in this study on A/S needed treatment within the 10 years.
If a man wants to further decrease his one percent probability of death he can select treatment, and a much higher probability of side effects. After 6 years some men in this study had side-effects from their treatment.
A consideration is that the trial has statistics for only ten (10) years, and that the results might be different when longer data is available, but for these results, men should have increased peace of mind.
The study does state that the cancer was more likely to progress and spread in the men on A/S than the treated men, but after the 10 years the one percent death rate included all three groups. As this test is continued, some men who were monitored now, MAY need treatment if they develop bone cancer because it is more frequent than in men who were treated at diagnosis
The anxiety factor was about the same in all 3 groups and monitoring is crucial in all the groups.
Dr D’Amico said, “ Men do not need to fear they might die because they have not chosen the “right” course of treatment.
It is estimated that about 50% of men now opt for A/S.

Stan’s Comments:
Comment #1
In the English study the PSA was repeated “every 6 to 12 months after the first year” and that “an increase of at least 50% during the previous 12 months triggered a review”. In the Boston area, and probably in the entire USA, the PSA test is repeated every 3 or 4 months for men doing A/S, and that a 20 or 25% increase would cause some concern and action.Twelve months is an extremely long time interval. I call this Occasional Surveillance.
It is possible that the severity of any follow-on treatment after a 20- 25% PSA increase would occur sooner, and would be less severe than after a 50% or larger PSA increase. Active surveillance with closer monitoring than used in this study might result in better results for active surveillance, and might decrease the death rate.
In addition, because in this country two or three biopsies are also done while on A/S, any change might result in earlier treatment, improving the A/S outcomes.
Is it possible because so many men were on the A/S protocol in the English Study, they did not have the time, personnel or funds to test more frequently? One doctor stated that monitoring in the UK study was not as vigilant as we do here although some argue we overdo it.
If a man wants to further decrease his one percent probability of death he can select treatment, and a much higher probability of side effects.

Comment #2
It is up to the Urologist to honestly present the benefits of A/S. They could drastically increase the number of men on A/S, but too many prefer not to for their own benefit. Dr. Otis Brawley, chief medical officer at the ACS said over 1,000,000 US men are getting needless treatment.

Comment #3
Men should tell anyone or family with pc to do not rush to judgement !
They should never be treated without consulting with all three pc specialists, especially the medical oncologists, and doctors who are active researchers.

ADT May Raise Risk of Alzheimer’s R1158
A new Journal of Clinical Oncology Study, lead by the University of Pennsylvania, analyzed the records of 5.5 million men on Androgen Deprivation Therapy (ADT), said
these men were significantly more likely to be diagnosed with Alzheimer’s Disease in the years that followed.
Their findings do not prove that ADT causes Alzheimer’s, and more studies need to occur said the lead author, Dr. Kevin T. Nead.
There is evidence that men who develop Alzheimer’s Disease tend to have lower levels of Testosterone. ADT lowers testosterone. The men on ADT were 88 % more likely to be diagnosed with Alzheimer’s, and the longer the ADT lasted, the higher the probability of being diagnosed with this disease.
There is evidence that low levels of testosterone are linked to obesity, diabetes, depression, impotence, heart disease, and high blood pressure.
Medical News Today, December 8, 2015See page 3 at: http://www.ustoo.org/PDFs/HotSheets/hotsheet012016.pdf

Active surveillance — in which prostate cancer is regularly monitored for signs of progression — spares men whose tumors may never progress from potential treatment-associated adverse effects, such as sexual dysfunction or incontinence.
This approach is especially common among men who are older and have limited life expectancies, as well as among younger men who want to ensure they maintain a high quality of life until treatment becomes necessary.
“Active surveillance does not mean ‘don’t treat,’” Matthew R. Cooperberg, MD, MPH, associate professor of urology and epidemiology & biostatistics at University of California, San Francisco, told HemOnc Today. “It means, ‘Don’t treat now and follow carefully with every intention of cure if there is progression.’”
The strategy has gained considerable acceptance. In community-based practices, the percentage of men with low-risk disease who underwent active surveillance climbed steadily from 6.7% in 1990 to 14.3% in 2009, a study by Cooperberg and colleagues showed. Between 2010 and 2013, the figure exceeded 40%.
Proponents contend active surveillance is a viable option because mortality rates among men whose tumors are limited to the prostate are low, and many of these men never experience symptoms from their disease.
However, some urologic oncologists question active surveillance as a standard management strategy and contend its use should be limited.
They emphasize repeat biopsies — necessary to monitor for disease progression during active surveillance — can still negatively affect quality of life. Questions also remain about whether risk stratification is an appropriate guide for active surveillance.
The debate about whether active surveillance is suitable for patients with intermediate-risk disease — who may sacrifice the chance to have their cancer treated at its most curable stage — is particularly contentious.“By definition, the number of men who die because they went on surveillance is very low but cannot be zero — that’s the law of nature in cancer,” Cooperberg said. “If you have thousands of men on active surveillance, a few of them are going to miss the window. But, this number is likely much smaller than the number of men seriously harmed by avoidable surgery or radiation therapy.”HemOnc Today spoke with oncologists and urologists about the benefits and risks of active surveillance, the factors that most affect risk stratification, the differences between active surveillance and “watchful waiting,” and how disparities among black patients may affect their outcomes in this setting.An established approachMonitoring disease rather than immediately commencing treatment is not a new concept. Active surveillance is a new way to describe — with modifications — what used to be known as watchful waiting.
Chodak and colleagues published data in 1994 in The New England Journal of Medicine that showed men with grade 1 or grade 2 prostate cancer could safely undergo conservative management and delayed hormone therapy without significantly affecting DFS.
Watchful waiting became common among men with well-differentiated and moderately well-differentiated cancers.
Today, these categories would refer to men with Gleason scores between 2 and 7. Because tumor grade can vary within a biopsy, Gleason scores are calculated by adding the most common Gleason grade in the sample with the highest grade to predict the likelihood of disease progression.
The concept of active surveillance involves more intense monitoring than watchful waiting, usually through frequent tests such as annual or biennial biopsies.http://www.healio.com/hematology-oncology/prostate-cancer/news/print/hemonc-today/%7B72922310-aec8-4298-834d-65dee9d542cc%7D/active-surveillance-redefines-paradigm-for-prostate-cancer-managementHemOnc Today

Stan’s Comment:This article went on for seven (7) pages with doctors trying to convince the reader not to do Active Surveillance (AS). Why? Because they want the income if the patient is treated, and other self serving reasons. Most of the doctors are Urologists, and some Radiation Oncologists, who advocate “treat now”
All that needs to be known are the words in red color above. As long as men meet the Active Surveillance Criteria, and are followed by a good doctor, why go looking for trouble? The death rate of men on AS is identical to men who are treated shortly after diagnosis, but the Quality of Life is far superior. Do it if you qualify?

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HIFU to treat prostate cancer approved R1142

Non-Invasive Robotic Surgery Destroys Prostate Cancer Tumors

Prostate cancer is the most common cancer in American men and is the fifth-leading cause of cancer death in men globally.
While death rates for prostate cancer have been decreasing in most developed countries, mortality rates are rising in some European and Asian countries such as South Korea, China and Russia. A non-invasive way of removing prostate cancer tumors is now available in the United States with the help of robotic technology.
The University of Southern California is the first academic medical center in the U.S. to perform this type of procedure.
Brett Lindsay knows he made history when he underwent a procedure known as robotic high intensity focused ultrasound, or HIFU.
“I was excited about the new procedure because it was more or less non-invasive. The recovery time was a lot quicker — did not have to remove the prostate,” Lindsay said.
The U.S. Food and Drug Administration recently approved the procedure even though it’s been used in other countries to treat prostate cancer for about 10 years. Traditional prostate cancer treatments include either removing the entire gland or radiation, which will affect the quality of life for patients even if the cancer is removed, said Inderbir Gill, lead urologist at the University of Southern California Institute of Urology at Keck Medicine of USC.
“The nerves that are lying right next to the prostate that are responsible for erections, the sphincter that’s lying right next to the prostate that is responsible for urinary continence, they get compromised. So, yes, you take care of the cancer, but you significantly impact the person’s quality of life,” Gill said.Only cancer is targeted.With HIFU, only the cancer is identified, targeted and destroyed. The HIFU procedure is an outpatient procedure, said Robert Barnett of SonaCare Medical, one of the manufacturers of the technology.
“Here we’re taking ultrasound energy off of a concave or bowl-like surface and bringing that to a focal point, and at that point we have tremendous heat generated and we can destroy tissue,” Barnett said.
HIFU devices are used in Western Europe, Latin America and some Asian countries, but not so much in developing countries.
“I think in the Third World if you will, in developing countries, it’s a financial thing. Those countries certainly don’t have the resources to commit to health care. Their focus is more on preventing infectious disease,” Barnett said.
But he said that, looking at the global cost of treating prostate cancer, HIFU technology is less costly than radiation and it can easily be implemented in an unsophisticated medical setting.
Gill said having the HIFU procedure at an academic medical center will allow them to further research the outcomes of HIFU procedures, minimize any side effects and advance the technology.
The objective is “to figure out what molecular and genetic markers predict HIFU success, HIFU failure. Which patients are the best candidates for it? How do we not overtreat cancer? How do we not undertreat cancer?” Gill said.
Brett Lindsay said he’ll relax at home for a few days before going on a business trip in less than a week.

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Incontinence data: What Doctors VS Patients report R1151

Managing Urinary Incontinence After Prostate Cancer Surgery Many men undergoing a radical prostatectomy for prostate cancer focus on erectile dysfunction as the major complication they face.
But in fact, following prostate surgery, men can confront another potentially more troubling complication: urinary incontinence. The incidence of serious incontinence at medical centers of excellence appears to be relatively low – in the 3 percent range. But if you look at overall national patient survey data, incontinence numbers are dramatically higher, in the range of 50 to 60 percent.
The good news is that most incontinence is temporary. However, for some men it persists – and will continue to persist unless you take the right steps to treat this condition, which if left untreated can lead to embarrassment and even social withdrawal.
Whether you are already experiencing incontinence symptoms — or you are a candidate for prostate cancer surgery and would like to take steps to reduce the risk of incontinence — this special health report provides the information you need.
Jacek Mostwin, M.D., D. Phil.(Oxon) is ideally positioned to write Managing Urinary Incontinence After Prostate Cancer Surgery.
Dr. Mostwin heads the Division of Reconstructive and Neurological Urology at Johns Hopkins Medicine, and has performed more than 3,000 radical prostatectomy’s and is an expert in bladder function in men and women.

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PSA Test more reliable when repeated R1143Prostate cancer test is more reliable if done twice.
A team of researchers in Ottawa, Canada, have discovered that unnecessary biopsies can be reduced by 60 per cent.10 Dec 2015 Nick Hodgson

A test for prostate cancer is more reliable if done twice, researchers have found, which could lead to a dramatic fall in unnecessary diagnostic surgery. The prostate-specific antigen (PSA) test has been used to help screen for prostate cancer for more than 20 years but it has been found to be unreliable, leading to calls for it to be abandoned. Now a team of researchers in Ottawa, Canada, have discovered that if it is repeated then its reliability increases, reducing unnecessary biopsies by 60 per cent. The research team reviewed the medical records of 1,268 men who had an abnormal (high) PSA test result and were evaluated at the Ottawa Regional Cancer Assessment Centre between 2008 and 2013. In 25 percent of these men, the second PSA test came back normal. Only 28 percent of men with conflicting test results underwent a biopsy compared to 62 percent of men who had two abnormal test results, representing a 60 percent reduction in biopsies. In addition, only three percent of men with conflicting test results who had a biopsy were diagnosed with cancer within the year, compared to 19 percent of men who had two abnormal tests, suggesting that the second normal test is important. The study is by The Ottawa Hospital and the University of Ottawa. Dr Rodney Breau, one of the lead reserachers, said: “A high PSA level is associated with a greater risk of prostate cancer, and PSA screening can help detect cancer at an earlier, more treatable stage. “However, PSA levels can also fluctuate because of infections, physical activity and laboratory error. Because of this variation, we implemented a protocol to always repeat an abnormal test before referring a patient for a biopsy. We had a hunch that this would reduce unnecessary biopsies and our study shows that our suspicion was correct.”HomeNewsHealthHealth News

Active Surveillance good for Intermediate Risk PC R1071Study provides evidence for new approaches to prostate cancerMonitoring prostate cancer (PC) by active surveillance (AS), with the expectation to initiate treatment if the cancer progresses, is a preferred initial option for men with low-risk PC and a life expectancy of at least 10 years. According to the results of a new study conducted at Brigham and Women’s Hospital (BWH), there is evidence to also support AS as an initial approach for men with favorable intermediate-risk of PC (men with no evidence of the cancer spreading beyond the prostate, a Gleason score of 3+4 or less and PSA, prostate-specific antigen, under 20). These findings are published online by JAMA Oncology.

“We found that men with favorable intermediate-risk prostate cancer did not have significantly increased risks of death compared to men with low-risk prostate cancer,” said Ann Caroline Raldow, MD, first author of the study and resident physician at BWH and the Harvard Radiation Oncology Program. “The clinical significance of our findings is that men with favorable intermediate-risk prostate cancer may also be able to avoid, or at least defer the side effects of, prostate cancer treatment, and enter an active surveillance program as an initial approach.”

Researchers estimated and compared the risk of PC-specific mortality (PCSM) and all-cause mortality (ACM) following brachytherapy, a high dose radiation treatment, among men with low-risk and favorable intermediate-risk PC in a prospective cohort study of 5,580 men (median age 68 years) at the Prostate Cancer Foundation of Chicago between 1997 and 2013. Men with favorable intermediate-risk PC, who had no more than half of all prostate biopsies containing PC, were included in the study and were treated with prostate brachytherapy alone.

The researchers found that men with favorable intermediate-risk did not have significantly increased risk of PCSM and ACM when compared to men with low-risk PC after a median follow up of 7.69 years. Additionally, the absolute estimates of PCSM were less than one percent in men with low-risk and favorable intermediate-risk PC, suggesting that men with favorable intermediate-risk PC may also be candidates for active surveillance.

To date, no direct comparison has been made between favorable intermediate-risk and low-risk prostate cancer with respect to PCSM or ACM following brachytherapy.

“While awating the results of ProtecT, a randomized trial comparing active surveillance with treatment, our findings provide evidence to support a discussion of AS as an initial approach to men with favorable intermediate-risk PC,” said Anthony Victor D’Amico, MD, PhD, senior author of the study and chief, BWH Genitourinary Radiation Oncology.Provided byBrigham and Women’s Hospital

“Available evidence does not conclusively show that PSA screening will reduce prostate cancer mortality, but it clearly shows an increased risk of harm,” says a Canadian Task Force on Preventive Health Care.The Task Force writes in the Canadian Medical Association Journal that the life time risk of prostate cancer death is only about 4 percent.People erroneously believe, ‘If I diagnose cancer early and I treat it, I get a better outcome” Dr. Neil Bell said. “For prostate cancer, that doesn’t hold for a number of reasons.”He and his colleagues write that about 70 percent of men between ages 70 and 79 are found to have undiagnosed prostate cancer after they die. Overall, they found strong evidence showing that men would likely experience more harm than benefit from PSA screening if they’re younger than 55 or older than 70.The researchers say that for every 1,000 men between ages 55 and 69 screened using PSA, one will be saved from death by the test. Of the other 999 who get screened by PSA, 720 will test negative. Of the 280 who will test positive, 178 will get additional testing – such as invasive biopsies – that ultimately show they don’t have cancer. Of the 102 correctly diagnosed with prostate cancer by the PSA screening, 33 will be diagnosed with cancer that would not have caused them to become ill or die and end up with complications related to their treatment. Five men will die regardless of whether they get PSA screening.

Recently The Prostate, Lung, Colorectal, and Ovarian Study (PLCO) said a specific man’s hair baldness pattern at about 45 years of age was very indicative that he would develop prostate cancer. (Note 1) The study interviewed 39,000 men.

Both baldness and prostate cancer have a strong male inheritance factor. What is of great interest to men who have the specified baldness pattern, is, “Will I develop prostate cancer?”To answer this question I separated the data into two groups, so I contacted the study lead medical researcher, Michael Cook, MD, and asked the following questions:Were the interviewed men separated into two groups, namely men with the specified baldness pattern who:A-Have a family history of prostate cancerB-Do not have a family history of prostate cancerI also asked whether the study asked if the men’s mother had the BRAC 1 or 2 Gene, as this is also a prostate cancer inheritance factor.If a larger percentage of men in group B develop prostate, then it would be more likely that the baldness is a factor and / or a predictor of developing prostate cancer.The replies were that the study did not ask about the mothers BRAC Gene, and they did NOT separate the men into group A or B Dr Cook said, “——-Therefore, men with any degree of baldness at any age should not in any way be additionally concerned about their individual risk of prostate cancer when reading the results of our study”.

Stan’s comment: Men have a 16 % chance of having prostate cancer, and if there is a family history, this percentage will increase.It appears that a high Testosterone level is a factor in men losing their hair, and also developing prostate cancer, so the hair loss is not a factor in men developing prostate cancer, but rather may explain why men lose their hair. It is possible that the hair loss pattern does not matter. Dr Cook said they are still analyzing the PLCO Data.

Note 1-A study being published online September 15, 2014 in the Journal of Clinical Oncology reports that men with a specific pattern of baldness at age 45 have a 40% increased risk of developing aggressive prostate cancer later in life, compared to men with no baldness at 45.

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Early Chemo Improves Survival

Men who have advanced prostate cancer who received chemotherapy early in their treatment, lived a median of nearly 14 months longer than men who did not receive early chemotherapy. If the cancer was more extensive, the survival was an even longer, 17 months. These are huge survival benefits.Dr Christopher Sweeney from the Dana-Farber Cancer Institute, leader of this study, reported this at the annual Conference of the American Society for Clinical Oncology, held in June 2014 in Chicago. This was reported in the Boston Globe, June 6, 2014

Lately, many doctors have written or spoken about Active Surveillance for men with prostate cancer. Almost every one has found something negative to say in very subtle ways so as to dissuade men from delaying treatment. Finally, a prominent doctor has come out and mentioned that delayed treatment is good, but still is holding back the entire story.Please remember the doctors who treat can do this because it benefits them, and because the overwhelming number of men with prostate cancer do not tell anyone about their cancer, so the newly diagnosed men is at the mercy of the doctors who want to treat. To read this article Epidemic of overtreatment of prostate cancer must stop, See 2.13 in the Active Surveillance/Watchful Waiting section. http://bostonpcsupportgroup.com/?page_id=1286

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Active Surveillance -Updated Information

The following article is very unusual in that it mentions the comparison of Survival and Quality of life factors. It is very strange that doctors who have spoken on Active Surveillance in the Boston area recently, and recent website articles all never mention Survival, and rarely mention Quality of Life; two crucial and vital considerations. At a recent meeting in the Newton Marriott Hotel in Newton, MA, I had to repeat three times that the statistics show that the survival is identical, before the reluctant speaker agreed. The data in this article stops at 20 years, but I am certain the data will be updated as time passes. I hope the men in an Active Surveillance program, are heartened by the following article. Stan

STOCKHOLM April 14, 2014— The longest follow-up to date of active surveillance in patients with favorable or intermediate-risk prostate cancer shows that it is a safe and feasible approach for as long as 20 years. Up to 20 years after diagnosis, 1.5% of the 993 men had died, and 3.1% had developed metastatic disease. In addition, death was 10 times more likely from other causes than from prostate cancer after diagnosis.”The question is how many men died of prostate cancer because they went on active surveillance instead of getting immediate treatment. The answer to that question is always going to be greater than 0,” Dr. Cooperberg explained. “However, we all think that it’s very, very, very low; it’s far lower, most likely, than the number of men who are harmed or potentially harmed from overtreatment for low-risk disease.”

The Article may be located at:http://www.medscape.com/viewarticle/715129

Stage 4 PC Now Covered by Social Security January 20, 2014BALTIMORE (WJZ)—A life-saving decision made by the Social Security Administration, (SSA), was announced Monday in Baltimore. Low-income men suffering from late stage prostate cancer will find the path to treatment is no longer full of obstacles. Now, stage four Prostate Cancer was added to its compassionate allowances. “This was an extremely important decision considering that 238,000 people men will be diagnosed with prostate cancer this year and considering, sadly, 29,700 plus may die. We are so pleased that this announcement was made,” said Rep. Elijah Cummings, D-Maryland. Cummings says many of his constituents have waited up to two years for a decision on disability benefits while they suffered through the pain of prostate cancer. “The process was so grueling that it delayed access to treatment, a death sentence for many of the individuals fighting this disease,” Cummings said. But now, with this change, decisions on disability benefits will be made within days instead of months or years. “The average processing time for a compassionate allowance claim for last year was 15 days as compared to 86.2 days or more through the normal process,” said Carolyn Colvin, acting commissioner of Social Security. “Men are able to live a lot longer with metastatic disease, and they are able to live a healthier life, so with these benefits these men and their families can live a much better life together. Compassionate allowances were launched in 2008 and have quickly approved benefits for more than 200,000 low-income Americans suffering from rare conditions and cancer.http://baltimore.cbslocal.com/2014/01/20/stage-4-prostate-cancer-among-25-conditions-now-covered-by-social-security/R904

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Are we over-diagnosing cancer? For decades the thinking was the sooner a cancer was treated, the greater the probability of a cure. Perhaps people survive early-stage cancers not because they’re treated in time, but because their disease never would have become life-threatening at all. Thanks to widespread screening, the number of early-stage cancers identified has skyrocketed. In many instances more early diagnoses haven’t led to proportionate decreases in mortality. (New drugs, not early detection, account for a reduction in -cancer mortality.) The cancers the tests pick up aren’t necessarily life-threatening. “We’ll all be cancer survivors if we keep going at the rate that we’re going,”says Peter Carroll, the chairman of the department of urology at the University of California at San Francisco and a specialist in prostate cancer. “Physicians, patients, and the general public must recognize that over-diagnosis is common and occurs more frequently with cancer screening,” Physicians, meanwhile, fear making a mistake, so it seems safer to treat someone who doesn’t really need it, than to miss something potentially fatal. But, the cancers that grow and spread very quickly are not the ones that you can catch in time with screening. By contrast, we do know that a lot of prostate cancer isn’t dangerous. Autopsy studies show it’s quite common in older men who die from unrelated causes. Dr. Peter Carroll, chairman of the department of urology at the University of California at San Francisco and a specialist in prostate cancer, has more than 1,000 patients under “active surveillance,” getting regular prostate tests, imaging and biopsies. Only about one in three turns out to need treatment within five to 10 years. (An additional 10 percent opt for surgery simply because they get tired of all the tests or can’t take the anxiety.) The program is also working, Carroll says, to “decrease the burden of testing,” ideally by eliminating the need for repeated biopsies. Stan’s Comment: The anxiety is often caused by doctors who stress treating for their own benefit. Thanks to better tests, Dr. Carroll notes, our ability to distinguish non-dangerous tumors is much better. We have the wherewithal now to be able to tell a patient that your cancer is highly likely confined to your prostate, of small volume, slow growing, and something that may not need immediate treatment at all.” Despite the widespread awareness that many prostate cancers aren’t life-threatening, many physicians are determined to find and treat it any time a test score comes in a little high, said Ian Thompson of the University of Texas Health Science Center at San Antonio, who is one of the JAMA authors . “The number of people that will die from those slow-growing prostate cancers is really low,” he says. 13 September, 2013 http://www.freenewspos.com/news/article/f/243722/Right%20Die/are-we-overdiagnosing-cancer R846

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Shorter ADT Treatments for Prostate Cancer630 patients with localized but high-risk prostate cancer were treated with only 18 months of hormone therapy. Men lived just as long as those treated for a more standard 36 months, a new study has found. This could mean much shorter treatment, sparing men months of unpleasant side effects, researchers said. “This may well change the standard of care,” said Dr. Bruce J. Roth, a prostate cancer specialist at Washington University in St. Louis. “Three years of hormonal therapy was almost picked randomly, and there’s nothing magical about that duration.” Hormone therapy is essentially chemical castration, with side effects, including hot flashes, loss of sexual desire, fatigue and the weakening of bones and muscles, and makes life “quite miserable,” said Dr. Abdenour Nabid of Sherbrooke University Hospital Center in Sherbrooke, Quebec, who was the lead investigator. After a median follow-up of about six and a half years, 77.1 percent of the men who received 36 months of therapy were still alive, as were 76.2 percent of the men treated for 18 months. The death rate specifically from prostate cancer was also the same after 10 years. There were also no statistically significant differences in the rate of biochemical failure Some doctors believe that 630 men is too small a sample and other doctors said more follow-up time is needed before coming to a conclusion. A version of this article appeared in print on February 13, 2013, on page B5 of the New York edition with the headline: Study Points to Shorter Prostate Cancer Treatments. New York Times-Business Day R724

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Management of High-Risk Localized Prostate CancerRecent studies have found that the combination of both surgery followed by EBR has a higher rate of cure, for men with a Gleason Score of 8, 9, or 10 even though the side effects are formidable. He will most likely also receive Androgen Deprivation Therapy. (ADT). It is rare that surgery alone will be a cure. Doctors rarely mention the need for follow-up EBR treatment. If a man is about 65 years or older, he may be treated with EBR only. The